MEDICARE: DR. JENNIFER K BANG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	M3154	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8AD156	OTHER	TX	BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396830071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER K BANG MD

Provider Business Mailing Address
First Line	:	4235 W NORTHWEST HWY
Second Line	:	SUITE 400
City	:	DALLAS
State	:	TX
Zip	:	75220-5047
Country	:	US
Telephone Number	:	214-750-5100
Fax Number	:	214-750-4500

Provider Business Practice Location Address
First Line	:	4235 W NORTHWEST HWY
Second Line	:	SUITE 400
City	:	DALLAS
State	:	TX
Zip	:	75220-5047
Country	:	US
Telephone Number	:	214-750-5100
Fax Number	:	214-750-4500

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	10/11/2013

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